Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
HIV Med. 2017 Oct;18(9):677-684. doi: 10.1111/hiv.12509. Epub 2017 Apr 26.
There is a lack of knowledge about the extent to which migrants become HIV-1 infected after arrival in European countries. The objective of this study was to assess the extent to which migrants to Sweden become HIV-1 infected post immigration using a CD4 T-cell decline trajectory model.
All migrants (n = 2268) who were ≥ 15 years old, were diagnosed with HIV-1 infection in the period 1983-2013, had a known year of arrival in Sweden, did not have primary HIV infection and were not infected via mother-to-child transmission were included in the study. The CD4 T-cell decline trajectory model was applied and estimates of HIV acquisition were compared to the clinical reports. Phylogenetic analysis was performed in a subset of patients to explore whether this would favour the model or the doctor's estimate.
The model estimated 19% of individuals to have been infected after arrival in Sweden, whereas the physician's estimate was 12%. In 79% of cases the estimates agreed. Discordance was predominantly seen when the doctor estimated HIV acquisition to have occurred before arrival in Sweden, while the model estimated it to have occurred after arrival in Sweden, and this type of discordance was seen in 10% of all patients. The probability of a discordance was greater for older patients, those with a high first CD4 T-cell count and those infected via heterosexual transmission. The phylogenetic analysis showed a higher concordance with the CD4 model than with the clinical reports (36 vs. 13%, respectively).
The model indicated that a substantially higher proportion of migrants are infected after arrival in Sweden than estimated using clinical routine reports. It is therefore important to further emphasize primary preventive measures among migrants who have established themselves in their new country.
对于移民在抵达欧洲国家后感染 HIV-1 的程度，人们知之甚少。本研究的目的是使用 CD4 T 细胞下降轨迹模型评估移民到瑞典后感染 HIV-1 的程度。
所有（n=2268）年龄≥15 岁、1983-2013 年期间诊断为 HIV-1 感染、已知抵达瑞典年份、无原发性 HIV 感染且非母婴垂直传播感染的移民均纳入本研究。应用 CD4 T 细胞下降轨迹模型，将 HIV 感染估计值与临床报告进行比较。对部分患者进行系统发育分析，以探讨这是否有利于模型或医生的估计。
模型估计有 19%的个体在抵达瑞典后感染，而医生的估计为 12%。在 79%的情况下，估计值一致。当医生估计 HIV 感染发生在抵达瑞典之前，而模型估计发生在抵达瑞典之后时，出现了主要的不一致，这种不一致在所有患者中占 10%。估计不一致的可能性随着患者年龄的增加、首次 CD4 T 细胞计数较高和异性传播感染而增加。系统发育分析显示，与临床报告相比，CD4 模型具有更高的一致性（分别为 36%和 13%）。
该模型表明，与临床常规报告相比，抵达瑞典后感染的移民比例要高得多。因此，在移民在新国家定居后，必须进一步强调初级预防措施。
